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Flashcards in Antivirals Deck (96)
1

HSV/ VZV- correspond to what HHVs

1,2,3

2

First line Tx for HSV, VZV

Acylovir, Valacyclovir, Penciclovir, Famicilovir

3

Alternative Tx for HSV and VZV

Cidofovir, Foscarnet, Vidarabine

4

Acyclovir- Drug class

Nucleoside analog of Guanosine

5

Acyclovir- MOA

viral thymidine kinase converts Acyclovir to acylco GMP --> inhibits viral DNA pol, chain termination

6

Acyclovir- admin

Topical, IV, Oral- not absorbed well orally

7

Acyclovir- elimination

renal

8

Acyclovir MOR

viral TK or viral DNA polymerase mutation

9

Acyclovir t1/2

3 hr

10

Acyclovir AE

Acyclovir has poor solubility, ensure adequate hydration to prevent crystalluria

11

Valcyclovir- Structure

Ester of Acyclovir

12

Valcyclovir advantages

Increased water solubility increases bioavailability

13

Pencicilovir Structure

Add OH group to Acyclovir

14

Penciclovir Advantage

increases intracellular concentration, prolonging the intracellular half life

15

Pencilovir Chain termination

Not an obligate chain terminator

16

Famciclovir Structure

Ester of Penciclovir

17

Famcilovir Advantage

More water soluble & Inc half life

18

Cidofovir structure

Nuleotide analog of Cytidine Monophosphate

19

Cidofovir activation

independent of the virus

20

Cidofovir MOA

viral DNA polymerase inhibitor --> chain termination

21

CIdofovir- Admin

IV

22

Cidofovir elim

Renal

23

Cidofovir- Uses

Resistant HHV1,2,3 and CMV (HHV5)

24

Cidofovir AE

dose limiting renal toxicity ensure is pre hydrated with IV saline

25

Cidofovir + Probenacid

Give probenacid to dec renal elimination of Cidofovir

26

Foscarnet Structure

Pyrophosphate analog

27

Foscarnet MOA

binds to pyrophosphate binding site of viral DNA pol --> inhibits it

28

Foscarnet Admin

IV

29

Foscarnet elim

Renal

30

Foscarnet AE

renal toxicity, prevent via hydration

31

Foscarnet resistance

mutation in viral DNA polymerase

32

Vidarabine Structure

Adenosine analog

33

Vidarabine MOA

viral TK coverts it to Ara- MP --> Ara- ATP inhibits viral DNA pol BUT NOT A CHAIN TERMINATOR

34

VIdarabine MOR

mutation in viral DNA pol

35

Vidarabine uses

Topical treatment for herpes keratitis. Limited systemic value b/c of metabolic inactivation and high toxicity

36

Tx for CMV

Cidofovir, Ganciclovir, Valganciclovir

37

Ganciclovir structure

similar to acyclovir but altered to be an inhibitor of UL97

38

Ganciclovir Admin

IV, not absorbed wel orally

39

Ganciclovir Elim

renal

40

Ganciclovir AE

myelosuppresion that is potentiated when given with Zidovudine (AZT)

41

Gancilovir Resistance

UL97 or DNA polymerase mutation

42

Valgancilovir structure

Ester of Ganciclovir

43

Valganciclovir advantages

Increased bioavailability compared to Ganciclovir

44

HBV Tx

Lamivudine, Adefovir, IFN alpha

45

Lamivudine structure

Cytidine analog

46

Lamivudine MOA

NRTI + chain terminator

47

Lamivudine admin

Oral

48

Lamivudine excretion

renal

49

Lamivudine AE

fairly non toxic

50

Lamivudine resistance

rapid and common

51

Adefovir Structure

AMP nucleotide

52

Adefovir MOA

nucletoide RTI

53

Adefovir use

alternative CMV tx if resistant to lamivudine

54

Adefovir admin

oral

55

Adefovir excretion

Renal, as adefovir

56

Adefovir resistance

None up to 1 yr

57

Adefovir AE

Dose limiting renal toxicity

58

IFN alpha how do you get it

Recombinant protein

59

IFN alpa MOA

immune cytokine that activates non selective immunity (macrophages and NK cells) and stops replication in virally infected cells

60

IFN alpha admin

subcutaneous or IM

61

IFN alpha AE

Feel sick- fever, flu like, injection site reactions. Bone marrow suppression

62

IFN alpha CI

autoimmune disease, hepatic decompensation

63

HCV tx

IFN alpha, Ribavirin

64

IFN alpha in HCV

prophylaxis and chronic infection

65

Ribavirin use only with?

IFN alpha

66

Ribavirin structure

guanidine/ adenosine dual analog

67

Ribarvirin MOA

inserts itself into mRNA and causes hypermutation NOT A CHAIN TERMINATOR

68

Ribavirin admin

oral

69

Ribavirin elim

renal

70

Ribavirin AE

dose limiting renal toxicity b/c stored in RBC for entire 90 day life span

71

Ribavirin CI

Pregnancy

72

Influenza A tx

Amantadie, Rimantadine, Oseltamavir, zanamavir

73

Amantadine MOA

M2 blocker

74

Amantadine uses

only prophylactic and treatment of suspected influenza A infection

75

Amantadine admin

Oral

76

Amantadine elim

renal

77

Amantadine resistance

frequent but strain dependent

78

Amantadine AE

abdominal pain. Crosses BBB and is dopaminergic- agitation, hallucination, cardiac arrhythmias, death if OD

79

Rimantadine MOA

M2 inhibitor

80

Rimantadine uses

prophylaxis and Tx and influenza A infection

81

Rimantadine admin

Oral

82

Rimantadine metabolism

liver

83

Rimantadine excretion

renal

84

Rimantadine resistance

Exists

85

Rimantadine AE

GI, but less BBB penetration than amantadine so less CNS side effects

86

Oseltamavir Name

Tamiflu

87

Oseltanavir MOA

Sialic acid analog that blocks neurominidase for prophylaxis and early tx

88

Oseltanavir admin

Oral

89

Oseltanavir AE

GI toxicity

90

Oseltanavir resistance

high

91

Oseltanavir uses

Influenza A and B

92

Zanamavir MOA

sialic acid analog that blocks neuriminidase for propyxlaxis and early tx

93

Zanamavir admin

Nasal

94

Zanamavir AE

respiratory toxicity- bronchospasm

95

Zanamvir CI

Pulmonary disease

96

Influenza B tx

oseltamavir and zanamavir